Providers electronically billing the County of San Diego and the Country of Santa Clara, be advised that the clearinghouse utilized by these claims administrators is erroneously, systematically rejecting provider e-bills.

A clearinghouse is a vendor hired by the claims administrator to respond to providers’ e-bills on the claims administrator’s behalf. When the clearinghouse incorrectly rejects a compliant e-bill, the clearinghouse does not forward the e-bill to the claims administrator; therefore, the claims administrator cannot pay the e-bill.

Currently, the clearinghouse Data Dimensions (formerly WorkCompEDI) is falsely rejecting e-bills sent by providers for the claims administrators noted above. daisyBill has contacted Data Dimensions as follows:

• On 3/29/2022, daisyBill reported to Data Dimensions the improper rejections of e-bills submitted by providers to the Counties of San Diego and Santa Clara.

• Communication from Data Dimensions indicates that EK Health, the claims administrators’ bill review vendor, failed to provide an accurate ‘claims feed’ to Data Dimensions, leading to improper rejections. As of 5/16/2022, this e-billing non-compliance remains unresolved.

When a clearinghouse falsely rejects an e-bill submitted by one of our clients, daisyBill undertakes the following steps:

1. Designates the e-bill with a DaisyBill Researching status
2. Contacts the claims administrator’s clearinghouse to report the false e-bill rejection
3. Resubmits the rejected e-bill on behalf of our client once the clearinghouse reports fixing the error,
4. Monitors the e-bill until it is ultimately accepted by the clearinghouse and sent to the claims administrator for processing
5. Appends a Non-Compliance Alert to each e-bill history affected by the EDI error

In order for providers to resubmit falsely rejected e-bills for payment, the claims administrator, bill review, and/or clearinghouse entities must repair the underlying technical error causing the improper e-bill rejections.

Ultimately, California law and regulators hold the County of San Diego and County of Santa Clara responsible for its e-billing non-compliance, regardless of the failures of any of its vendors. Per the California Division of Workers’ Compensation (DWC) Electronic Medical Billing and Payment Companion Guide:

Billing agents, electronic billing agents, third party administrators, bill review companies, software vendors, data collection agents, and clearinghouses are examples of companies that may have a role in electronic billing. Entities or persons using agents are responsible for the acts or omissions of those agents executed in the performance of services for the entity or person. [emphasis added]

When a claims administrator fails to adhere to California e-billing requirements, daisyBill notifies our clients by appending a Non-Compliance Alert to the Bill History for each e-bill affected by the EDI error, as shown below.

5/16/2022

In late March, daisyBill discovered that County of San Diego and County of Santa Clara falsely rejected hundreds of compliant e-bills submitted by our clients with the erroneous rejection reason: CLAIM NOT FOUND.

Both of these self-administered claims administrators employ EK Health as their bill review vendor and Data Dimensions as their designated clearinghouse.

On 3/29/2022 daisyBill alerted Data Dimensions to the 277 ACK rejection error. As of 5/13/2022, Data Dimensions continues to falsely reject e-bills submitted to the County of San Diego and County of Santa Clara (For more information, read How-To e-Bill: Improperly Rejected e-Bills Explained).

Communication received from Data Dimensions indicates the reason for the incorrect 277 ACK rejections is EK Health, the bill review vendor, failed to provide an accurate ‘claims feed’ to Data Dimensions.

🌼 As of now, daisyBillers do not need to take any action regarding this EDI non-compliance. On your behalf, daisyBill will resubmit all incorrectly rejected bills until the clearinghouse properly responds to these e-bills. Have a Flower Power Day!

daisyBill fights the good fight on behalf of workers’ comp providers. Reach out to see how we can help your practice obtain fast, correct reimbursement for treating injured workers.

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